We’ll do whatever it takes and then some.

Save money with a DeltaCare USA dentistDeltaCare USA plans feature:• Set copayments • No annual deductibles and no

maximums for covered benefits• Low or no out-of-pocket costs for many

diagnostic and preventive services (such as professional cleanings and regular dental exams)

Choosing your DeltaCare USA dentistWe have just enhanced our online dentist directory, making it even easier for you to find a conveniently located DeltaCare USA dentist. To find the most current listing of DeltaCare USA network dental offices: • Visit our website on your mobile

device or desktop, and click on “Find a Dentist” on our home page.

• Select “DeltaCare USA” as your plan network.

You can also call Customer Service for help in finding a dentist.

Visit your DeltaCare USA dentistYou must visit your selected DeltaCare USA dentist to receive benefits under your plan.*• If you do not select a dentist, we will

select a dentist for you.

• Family members may select a different dentist for treatment within the covered service area. Refer to your plan booklet for details.

• You can change your selected network dentist by telephone or through our website.

• Changes received by the 21st of the month will be effective the first day of the following month.

Easy to use• We will notify your DeltaCare USA

dentist about your enrollment in the plan and other important details about your coverage, such as dependent information, group number and enrollee ID number.

• No ID card is required to receive services; simply provide the dental office with your name, date of birth and social security or enrollee ID number.

• With DeltaCare USA, there are no claim forms to submit. And, because you are responsible only for the copayment at the time of treatment, you will not receive a claims statement.

• Predictable costs: you’ll find a complete list of covered procedures, copayments, plan limitations and exclusions in your plan booklet.

A REGISTERED MARK OF DELTA DENTAL PLANS ASSOCIATION

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DeltaCare® USA — Getting the most from your plan

With DeltaCare USA, there are no claim forms to submit.

For employees in AL, AR, AZ, CA, CO, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, MD, MI, MO, NC, NJ, NM, NY, NV, OH, OR, PA, RI, SC, TN, TX, UT, VA, WA, WI, WV

Select a DeltaCare USA dentist

Schedule an appointment

Receive dental care

Pay only yourcopaymentdirectly todentist

Receive yourwelcome kit

*State-specific exceptions may apply. Please review your plan booklet for specific details about your plan.

With DeltaCare USA, you and your family will enjoy many features including:

Expanded business

hours/toll-free customer service

Out-of-areaemergency coverage

Orthodontic

treatment in progressprovision

Specialty care and authorizationsIf you require treatment from a specialist, your DeltaCare USA general dentist will coordinate any referrals for you.

In some states, Delta Dental must pre-authorize any dental services, with the exception of emergency treatment, that are not performed by your DeltaCare USA general dentist. Please refer to your plan booklet for specific details about your plan.

Dual coverage/Coordination of benefitsIf your spouse has coverage with another dental plan, you or your family members may be covered by both dental plans.**

• We do not coordinate benefits with the other plan when you receive treatment from your DeltaCare USA general dentist. However, if you receive authorized treatment from a specialist (such as an oral surgeon), we will coordinate benefits with the other carrier.

• Ask your specialist to submit the other plan’s explanation of benefits with the DeltaCare USA claim form, and we’ll take it from there.

Sign up for an online account at: deltadentalins.comUse your mobile device or your desktop to:

• Find a dentist in our enhanced online directory

• Review benefits

• Verify eligibility

• View your ID card on your mobile device, or print it from your desktop

To access some services, you’ll need to log in: simply enter your username and password in the designated boxes and

submit. If you are visiting our website for the first time, you’ll need to complete a quick one-time registration process by clicking the “Register Today” link.

Questions about your plan?If you have questions, you can check your benefits and eligibility information on our website or on our interactive voice response telephone line. For more information, you may also contact us through our website or call one of our helpful multilingual Customer Service representatives toll-free during business hours.

E EF17_DCU_USA #71119 (rev. 11/12)A REGISTERED MARK OF DELTA DENTAL PLANS ASSOCIATION

DeltaCare® USA is underwritten in these states by these entities: AL — Alpha Dental of Alabama, Inc.; AZ — Alpha Dental of Arizona, Inc.; CA — Delta Dental of California; AR, CO, IA, MI, NC, OR, RI, SC, WA, WI — Dentegra Insurance Company; DC, DE, FL, GA, KS, TN and WV — Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX — Alpha Dental Programs, Inc.; NV — Alpha Dental of Nevada, Inc.; UT — Alpha Dental of Utah, Inc.; NM — Alpha Dental of New Mexico, Inc.; NY — Delta Dental of New York, Inc.; PA — Delta Dental of Pennsylvania; VA — Delta Dental of Virginia. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products.

800-422-4234

** Group-specific exceptions may apply. Please review your plan booklet for specific details about your plan’s coordination of benefits, including rules for determining primary and secondary coverage.

*** This provision may not apply to all plans. Please refer to your plan booklet for specific coverage details.

SmileWay® Wellness Program

DeltaCare USA Customer Service

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Why do 1.4 million enrollees trust their smiles to DeltaCare® USA?

• Largedentistnetwork • Easytouse • Affordablecosts • Extensivecoverage,

including orthodontics

WE KEEP YOU SMILING®

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Connect with us!

Find all of our dental health resources, including risk assessment quizzes, articles, videos and a free e-newsletter subscription, at: mysmileway.com.

deltadentalins.com/enrollees

Your DeltaCare USA plan covers treatment started and completed only after your plan’s effective date of coverage. However, DeltaCare USA plans have no exclusion for pre-existing dental conditions or missing teeth.

Orthodontic treatment in progressDeltaCare USA has an orthodontic treatment-in-progress provision that allows new enrollees to continue treatment with their current orthodontist, as long as the enrollee is in active treatment started under his or her previous employer-sponsored dental plan. Enrollees are responsible for all copayments and fees subject to the provisions of their prior dental plan.***

Transitioning from another plan?

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